Breast augmentation remains one of the most popular cosmetic surgeries year after year (and touts an impressive 97% Worth It Rating among RealSelf members). But breast augmentation isn’t always just about increasing breast size—it’s also one of the only ways to correct a condition known as tubular breasts. Here, plastic surgeons explain more about what causes tubular breasts, how to tell if you have them, and your options for correction.
What are tubular breasts?
Also known as tuberous breasts or constrictive breasts (we’ll use these terms interchangeably), this is a breast abnormality that has three distinct hallmarks. “The biggest one is an undeveloped portion of the bottom part, what we call the lower pole,” says Dr. John Paul Tutela, a board-certified plastic surgeon in Livingston, New Jersey. Normally, the area under the nipple is rounded and curved, but in the case of a tuberous breast, it’s pretty much a straight line from the nipple to the chest wall, he explains.
This coincides with another of the main distinctions, a high inframammary crease: “In a tuberous breast, the bottom of the breast sits very high up on the chest and very close to the nipple-areolar complex, with hardly any tissue in between,” explains Dr. Tutela. The final hallmark is a herniation of the breast tissue into the nipple-areolar complex, which makes the areola appear large and puffy, he adds.
What do tuberous breasts look like?
The condition is aptly named because tuberous breasts look like, well, long tubes. Without that bottom portion of breast tissue, the top part falls over, making the nipple appear to be at the bottom of the breast, sometimes even pointing downward, says Dr. Lisa Cassileth, a board-certified plastic surgeon in Beverly Hills, California, of tubular breasts’ distinct droopy and saggy appearance. As mentioned, large and puffy areolas are another telltale sign, though Dr. Cassileth says one of the surest signs of tubular breasts is that the distance between the bottom of the breast and the nipple is less than five centimeters.
It bears mentioning that this condition occurs at varying degrees of severity. “While classically tuberous breasts have those three criteria, there are plenty of women who have tuberous breasts but only one or two of the defining characteristics,” explains Dr. Troy Pittman, a board certified plastic surgeon in Washington, D.C. Point being, there’s a wide spectrum of tuberous breasts, and the severity can differ even from one breast to the other. In fact, there’s also an increased rate of asymmetry among tuberous breasts. “It’s rare that I see tuberous breasts that are even remotely symmetric, so that’s also something that needs to be dealt with during the surgical correction,” points out Dr. Cassileth.
What causes tubular breasts?
The condition begins from the outset of breast development in puberty. “A normal breast grows from a breast bud that sits underneath the nipple-areolar complex and spreads out, growing in four directions: medially on two different sides and laterally, up and down,” says Dr. Cassileth. “In the case of tuberous breast deformity, this tissue doesn’t spread out normally and instead just grows forward, like a tube.” Dr. Pittman adds that the Cooper’s ligaments, which support breast tissue, are also deformed. “In a normal breast, they extend straight from the chest wall out toward the nipple. In a tuberous breast, these ligaments, or bands, are circumferential, like a spider web, which also makes the breast tissue grow into a tubelike form.”
All that being said, the doctors we spoke with are quick to note that this is a congenital defect women are born with—there’s no known underlying cause. However, while Drs. Pittman and Tutela don’t feel that there’s a genetic or familial link, Dr. Cassileth says, that in her experience, she has seen the condition run in families.
How common are tuberous breasts?
Pretty common. According to Dr. Pittman, approximately 10% of the population has tuberous breasts to some degree; Dr. Cassileth feels it might be even more common than that, if you take into account very mild cases.
Can you fix tubular breasts without surgery?
That’s a hard no. All the doctors we spoke with underscore the fact that there’s absolutely no way to correct this condition without surgical intervention. However, there are many different ways tuberous breast surgery can be performed.
What is involved in a tubular breast augmentation?
Each doctor we spoke with has a slightly different technique. The unanimous, overarching point, however, is that a tubular breast augmentation is nothing like a traditional breast augmentation. “Simply putting it in an implant in the same fashion as you would in a normal breast is not going to yield good results at all. It’s paramount to find a breast surgeon who frequently operates on tuberous breasts, specifically,” notes Dr. Tutela. His preferred method is to create an incision to help lower the inframammary crease, then score the breast tissue in a radial fashion; this combination helps to break up the tight breast tissue that’s found in a tubular breast and create more expansion in the lower part of the breast. He prefers higher-profile implants—they project forward and exert the force needed to expand the tissue and bring shape to a breast that’s devoid of it, he says—which he places under the muscle.
Dr. Pittman almost always combines a breast augmentation with a breast lift for his tubular breast patients. “A vertical lift, where there’s a vertical incision at the bottom of the breast, helps to cut away those constricting Cooper’s ligaments at the bottom of the breast, allowing it to expand. During a breast lift, you can also reduce the size of the areola, treating that puffy appearance that is so common in tuberous breasts,” he explains. He places the implants in dual planes, under the muscle at the top of the breast and under the breast tissue at the bottom of the breast, so that the weight of the implant can help further stretch out this lower area, he says.
Dr. Cassileth takes a third approach. “The first thing I do is reposition the existing breast tissue, moving the tissue that’s there to a lower location in order to help cover the implant. I essentially unroll the trapped tissue that’s behind the areola, and then I can put it wherever I want,” she says, adding that doing so often improves the appearance of the areola almost instantly. She prefers subfascial implants, placed over the pectoral fascia, a tough layer on top of the muscle, saying that she finds this holds the implant in exactly the right place. Again, she notes that treating each breast as its own unique case is also paramount, given the likelihood of asymmetry. It’s worth noting though that “tuberous breast correction isn’t always implant dependent,” she says. “A combination of things such as repositioning the tissue, removing tissue if one breast is larger, and fat grafting can yield good results—and is a good option for patients who don’t want to think about replacing implants every 10 years for the rest of their lives.”
Does insurance cover tuberous breast correction?
Dr. Tutela says he’s never seen insurance cover any of his cases, but Dr. Cassileth says that in her experience, it depends on just how tuberous your breasts are—and on your insurance plan. “Insurance companies tend to look at pictures. If your breasts really look deformed in a photo, they’re usually more likely to cover it than if your breasts are just a little droopy or saggy,” she says.
